title: GLP1 analogs as treatment of postprandial hypoglycemia following gastric bypass surgery: a potential new indication?
abstract: OBJECTIVE
  The number of morbidly obese subjects submitted to bariatric surgery is rising worldwide. In a fraction of patients undergoing gastric bypass (GBP), episodes with late postprandial hypoglycemia (PPHG) develop 1-3 years after surgery. The pathogenesis of this phenomenon is not fully understood; meal-induced rapid and exaggerated increases of circulating incretins and insulin appear to be at least partially responsible. Current treatments include low-carbohydrate diets, inhibition of glucose intestinal uptake, reduction of insulin secretion with calcium channel blockers, somatostatin analogs, or diazoxide, a KATP channel opener. Even partial pancreatectomy has been advocated. In type 2 diabetes, GLP1 analogs have a well-documented effect of stabilizing glucose levels without causing hypoglycemia.
  
  
  METHODS
  We explored GLP1 analogs as open treatment in five consecutive GBP cases seeking medical attention because of late postprandial hypoglycemic symptoms.
  
  
  RESULTS
  Glucose measured in connection with the episodes in four of the cases had been 2.7, 2.5, 1.8, and 1.6 mmol/l respectively. The patients consistently described that the analogs eliminated their symptoms, which relapsed in four of the five patients when treatment was reduced/discontinued. The drug effect was further documented in one case by repeated 24-h continuous glucose measurements.
  
  
  CONCLUSIONS
  These open, uncontrolled observations suggest that GLP1 analogs might provide a new treatment option in patients with problems of late PPHG.
authors.affiliation: Departments of Medical Sciences, University Hospital.
authors.forename: Niclas
authors.initials: N
authors.lastname: Abrahamsson
authors.forename: Britt Edén
authors.initials: BE
authors.lastname: Engström
authors.forename: Magnus
authors.initials: M
authors.lastname: Sundbom
authors.forename: F Anders
authors.initials: FA
authors.lastname: Karlsson
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000378:metabolism; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects; D052216:Glucagon-Like Peptide 1 / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D006801:Humans; D007003:Hypoglycemia / Q000188:drug therapy* / Q000209:etiology; D054795:Incretins / Q000097:blood; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D019518:Postprandial Period; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D054795:Incretins; D052216:Glucagon-Like Peptide 1